All health care personnel, especially those in the rehabilitation field, are quite familiar with the frustrations that ischemic skin ulcers engender, particularly decubiti. When preventive measures prove unsuccessful, one is faced with the problem of enhancing tissue repair of the resultant lesion. A satisfactory method for the treatment of these lesions has eluded physicians for centuries, and the variety of therapeutic techniques is exceeded only by the number of resistant ulcers.Ischemic ulcers are, by definition, areas of chronic dermal and epidermal erosion in which local hypoxia plays a major role. Aggravating factors include a multitude of pathophysiologic processes; however, most of these ulcers are sequelae of chronic venous stasis with lower extremity varicosities, peripheral arterial insufficiency, or destructive forces that act on decentralized, denervated, or even normally innervated tissue.In the past, these lesions have responded most consistently to avoidance of pressure, cleanliness, and patience. A welcome break in this routine was described by Kanof' who reported the accelerating effect of ordinary gold leaf upon the healing of decubitus ulcers. Although the study was of limited scope, in terms of ulcer type and number of patients, the inherent potential of this unique regimen seemed to warrant further evaluation and investigation.Our evaluation of the gold leaf treatment* indicated a significant acceleration in healing rate. Of particular interest was the electrometric evidence that dissipation of the negative charge from the leaf was complete in about 48 hr and also that infected ulcers were aggravated by the negatively charged gold foil. It was hypothesized that the external application of a negatively charged substance (e.g., gold leaf) forms a dipole configuration with the adjacent tissue, whose polarity thereby becomes relatively more positive and catalyzes anabolism.Armed with this hypothesis, we next evaluated healing with applied direct constant current of known intensity by means of a constant-current generator with an output range of 200-1000 PA. The treatment regimen, which utilized lowintensity direct current (LIDC), produced a healing response clearly superior to that achieved with gold leaf. Subsequent refinement of the treatment protocol has resulted in a substantial improvement in healing rate over our initial results.We were surprised to find that the effects of polarity were the opposite to those
in Partial Fulfillment of the Requirements for the Degree of MASTER OF ENGINEERING Approved May, 1976 Moll ACKNOWLEDGMENTS I would like to thank those people who volunteered their time to serve as subjects for my study. In addition, I am Indebted to Professors Blair A. Rowley and Dwane E. Anderson for their advice in preparing this paper. I would also like to thank the other menders of my committee. Professors William B. Jarzembski and Mohamed M. Ayoub, for their assistance. Finally, I would like to thank my father, Mr. George F. McCarroll, for his assistance In the preparation of the Illustrations for the text.
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